Individual provider Active NPI

Massih Etemadi, DMD

  • Dentist
  • Everett, WA
National Provider Identifier
1700579216
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE61435139 Issued in WA
Practice address
2121 Madison St Ste a
Everett, WA 98203-5375
Phone
(425) 353-5854
NPI assigned
May 31, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE61435139 WA Primary

Addresses

Primary practice location

2121 Madison St Ste a
Everett, WA 98203-5375

Mailing address

18713 136TH Ave NE
Woodinville, WA 98072-5732

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240924004602 WA Order and Referring Only - DentistPractitioner - Dentist 6608317110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE61435139WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Heidi Johnson DDS, PLLC CurrentSince Nov 9, 2025 Accepting new patients
M Etemadi DMD PLLC Dentist CurrentSince Nov 9, 2025 Accepting new patients

Locations

2121 Madison St
Ste A
Everett, WA 98203
Phone (425) 353-5854

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1700579216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18713 136TH AVE NE",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980725732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MADISON ST STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982035375",
            "telephone_number": "425-353-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETEMADI",
        "first_name": "MASSIH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61435139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.